A “smart” way to enhance mental health care

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When Walter Osoka first began experiencing mental health challenges in the late 1980s, cell phones were a novelty and reaching a care provider outside of a scheduled appointment was not common practice. Now a mental health advocate, he has seen first-hand the challenge for some mental health outpatient clients who are discharged from hospital treatment to communicate regularly with their community-based care provider.

“A lot of mental health care time is wasted on traveling and waiting,” says Walter, who adds that many clients don’t have a phone or a car, or any easy way to keep in contact which puts them at risk for serious outcomes when they are in need of immediate care. Another challenge for many is that health records are not centralized or easily accessed at a time of crisis.

“The most common cause of death among people with psychotic or mood disorders is suicide,” says Dr. Cheryl Forchuk, lead project researcher and assistant director at Lawson Health Research Institute, the health research institute of London Health Sciences Centre and St. Joseph’s Health Care London. “That is why maintaining communication between client and community-based care providers, and fast and reliable access to health records, is essential to preventing re-admission to treatment, homelessness, and worse outcomes.”

Two years ago, Dr. Forchuk and Lawson’s Mental Health Group held a retreat to collaboratively look for answers to these challenges. The team included researchers, clinicians, and clients themselves – all working to come up with better and more creative solutions, not only to help clients better communicate with care providers, but also to give them tools that help them play a more active role in their own care.

Recognizing the mobility and increasing functionality of cell phones, the team devised a solution to develop and evaluate a mental health system that takes advantage of new smartphone technology.

Walter has been working with Dr. Forchuk and the team to pilot a new two-year, two-phase project. It was officially launched on October 12, 2012, at an event attended by Deb Matthews, Ontario’s Minister of Health and Long-Term Care, as well as leaders from project partners, Canada Health Infoway and TELUS Health. Both organizations are committed to supporting initiatives that develop and implement innovative mobile electronic health technology to help Canadians manage their health and produce better health outcomes.

The pilot is providing 400 community-based mental health clients with an iPhone loaded with a custom-designed app that gives them access to the new Lawson SMART record. The tool leverages TELUS health space®, powered by Microsoft® Health Vault® – a secure online consumer health platform, certified by Canada Health Infoway – that allows patients to collect, manage and share their health information. Stored securely online, this record includes their personal health information (i.e. treatment history and a list of medications and care providers), as well as tools—developed in consultation with a care provider—to help continue their recovery.

“With this technology, clients can now simply send their care providers a secure text message saying, ‘this is what’s going on right now.’ As care providers, we will be much better able to help and intervene earlier,” says Dr. Forchuk.

This two-way point of contact between clients and caregivers will give individuals diagnosed with a mental illness a greater role in managing their own care. Clients will work with their care providers to use the SMART record to develop a personal care plan, including prompts and reminders for appointments and activities. It even has a mood monitor and exercise tracker—all available at their fingertips from the iPhone. “It’s empowering people to participate more actively in their own care,” says Dr. Forchuk.

The SMART record also ensures that everyone who needs access to a client’s health information – the clients themselves, as well as their formal and informal network of caregivers – have it when they need it. And there are potential benefits beyond improved outcomes for the client. It points the way to a whole new model of care that may relieve stresses on the system and deliver significant cost savings at the same time.

Lawson “SMART” record

The “SMART” record houses personal health information, giving mental health clients ready access to their treatment history, medications, crisis and discharge plans, and care providers over the years. The pilot project is currently testing and refining the tools available on the “SMART” record, which all helps continue their recovery in the community. For example, the mood tracker allows them to determine their mood at any given time (on a scale of one to seven) and share that number with their care provider. By setting prompts and reminders, patients can be reminded about upcoming appointments, when to take medications, or even when to exercise.

The iPhones provided in this pilot project are password protected and the “SMART” record is a web-based app so even if the phone is lost, there are no patient confidentiality issues.